1. Buniyaad: Reducing infant mortality through
optimal infant feeding practices
Abhishek Singh, Programme Manager, Buniyaad
Programme

2. Introduction
• Duration: April 2012- March
2015
• 426,587 mothers of children
under two years of age among
the poorest and most
marginalized populations
• Intervention area and
implementing partners
– Muzaffarpur – AKRSP,I and
AKF,I
– Samastipur – AKRSP,I and
Agragami, India
– Sitamarhi – CHARM

3. Project Geography
Districts 3
Blocks 20
Panchayats 387
Villages 1436

4. Project Rationale
• Bihar has poor child
survival indicators: IMR- 52,
NMR- 34, U5MR- 73 [AHS
2011-12]
• Optimal IYCF practices
directly impacts child
survival
• AKF implemented a 3 year
project - Buniyaad - in 3
districts of Bihar
• The effort was aimed at
demonstrating a workable
model for adoption of
optimal IYCF practices

5. Goal and Outcomes
Goal:
Reduction of neonatal and infant
mortality through optimal IYCF
practices among mothers of
children under two years, through
effective BCC strategies.
Outcomes:
• Improved rate of early initiation
of breastfeeding within an hour
of birth.
• Improved rate of exclusive
breastfeeding of infants for the
first 6 months of age.
• Improved rate of age
appropriate complementary
feeding given to the child
beyond six months of age, with
continuation of breastfeeding.

6. Insights from Formative Research
Early Initiation
• Knowledge is there in community. Practice varies for institutional & home delivery.
• Institutional delivery: Within a few (2-3) hours of birth since advised by doctor;
delay because of cleaning baby and giving mother some time to rest.
• Home delivery: Few hours to even 2 days; delay because wait for religious reasons.
• As BF delayed, pre-lactal feeds given to assuage child’s hunger. Sugar water, honey,
cow’s milk most popular.
Exclusive Breastfeeding
• Do not understand “exclusive” BF, often include water to quench thirst.
• Apart from water, some initiate top foods / fluids before six months because
perceive there is “not enough milk”.
• Believe “not enough milk” when:
- Blouse not wet with milk / no fullness
- Child cries a lot even after feeding
Complementary feeding
• Biscuits serve as test food for readiness to eat.
• No transition from semi-solids to solids, no modification of food for child.
• No pro-active feeding (quantity, frequency) – base feeding on child’s demand and
hunger.

7. The BCC Strategy
Level 1:Household Level
Mothers in 3rd trimester and with
children upto 2 years of age
Level 2: Community-based service
providers
ASHA, AWW
Level 3: Facility-based service
providers
ANMs, Mamtas
Level 4: Policy influencers
GoB, Development Partners, other
Professional bodies

8. Interpersonal
communication
(IPC)
Mid-media
Mass- media
Healthy
Baby shows
4500
Breastfeeding
& Nutrition
Week
Radio
Spots
Home
Visits
592,866
Group
Meetings
167,256
Level 1: Household level
Wall
writings
2800

9. Involvement in
home visits &
group meetings
Joint
celebration of
key events
Participation in
monthly review
meetings
Exchanging regularly
updates (18 district
level meetings and
240 Block Level
Meetings)
Orientation/ Trainings
(AWW–2814, ASHA–3527,
ANM– 674 and MAMTA -
243)
Level 2 & 3: Community and Facility level service
providers

10. Level 4: Policy Influencers
• AKF part of key Government initiatives as part
of committees, sub-committees, etc.
• Mass media initiatives (wall writings, radio
spots) in consultation with Government
Govt. of Bihar
• Resources for trainings and updates on IYCF
• Opportunities for exposure to their initiatives
Professional
bodies
• Resources for trainings and updates on IYCF
• Opportunities for exposure to their initiatives
• Joint partnership in influencing Government
on key IYCF issues
Development
Partners

11. Achievements

12. Key Indicators
Indicators
Project
baseline
(Sept-Oct
2012)
Achievements
Year 1
March 2013
Year 2
Jan-Mar
2014
Year 3
Jan-Mar
2015
Early Initiation of Breast feeding
(Proportion of mothers with newborns less than 7
days old who report having breastfed their
newborns within one hour of birth)
17.4 23.1 44.6 65.24
Exclusive breast feeding
(Proportion of mothers with a child 6-7 months of
age who have exclusively breastfed their child for at
least six months)
15.2 20 33.9 49.63
Complementary feeding
(Proportion of mothers with a child 6-7 months of
age who have introduced complementary feeding
for their child)
73.4 74.9 79.8 87.19
Age appropriate Complementary feeding
(Proportion of mothers with a child aged 12-13
months who are giving age appropriate
complementary feeding for their child)
19.8 22.1 29.9 44.08

13. 17.4
23.1
44.6
65.2
15.2
20.0
33.9
49.6
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
BASELINE (OCT'
2012)
(MARCH 2013) (MARCH 2014) (MARCH 2015)
EIBF Achieved EBF Achieved
Breastfeeding
Initiation of Breastfeeding before 1 hour of Birth
Exclusive Breastfeeding till six month

14. Complementary Feeding
73.4 74.9
79.8
87.19
19.8
22.1
29.9
44.08
0
10
20
30
40
50
60
70
80
90
100
BASELINE (OCT' 2012) (MARCH 2013) (MARCH 2014) (MARCH 2015)
Introduction of Complementary feeding Age Appropriate Complementary feeding
Introduction of Complementary feeding at the age
of 6 Month
Age Appropriate Complementary Feeding to child
aged 12-13 olds

15. Learnings and Challenges
• Need for dedicated nutrition counselor in community
to provide information & training.
• Great utility of communication kits.
• Government frontline workers not able to
adequately explain concepts. Knowledge is not
enough – need to be trained on how to communicate
and explain so can bring about belief and behaviour
change.
• Continued use of water to feed babies.
• Need to adapt BCC tools and messaging as you
implement so that progressively can address
challenges.

16. Thank you!